Let’s Talk about Shredded Romaine Lettuce

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So the situation was: our niece Amy up at 4:20 a.m. with vomit out one end and diarrhea out the other, except diarrhea not so much diarrhea-y but rather small particles of waste in bloody slurry. Amy’s parents and three sisters sleeping the profound sleep of the post-Christmas holiday-exhausted, so Amy, age 11, procured old towels used to wipe off Lynx (Irish Setter) when he came in from yard with dirty paws, set them up as nest in bathroom, and just sort of bled and vomited until light of day. Not really so bad (it would, after all, get so much worse) other than nastiness of forced evacuation of Stouffer’s lasagna consumed at dinner with large glass of orange juice and then the long stretch of dry heaving afterward. Amy grateful for one thing: had iPad for company.

One place iPads are made is Chengdu, China. Shifts run 24 hours a day. Blinding lights plague the eyes of Lai Xiaodong. Who is Lai Xiaodong? Well, in 2010, he left his home for the city of 14 million to work at Foxconn’s factory in Chengdu. Such a shy young man, yet he’d convinced a beautiful nursing student to marry him and wanted to earn money to buy an apartment. For now, Lai works 12 hours per day and earns about $22. Gets room in dorm just large enough for a mattress and desk and wardrobe. Works with thousands of others with swollen legs from standing all day. But still: a job! Sign on wall says, Work hard on the job today or work hard to find a job tomorrow. Words to the wise. Some workers don’t even have their own rooms. Twenty people stuffed into a three-room apartment. Rodent problems. Bummer for those workers. Things could be a lot worse, Lai tells himself. (Things will get a lot worse.)

And then the explosion. Super-downer. Or whatever Chinese phrase is the equivalent to “super-downer.” One Friday evening in May, workers covered in sparkling aluminum dust stand there buffing iPad cases nonstop. Over there (difficult to ascertain exactly which worker Lai is, as all are wearing masks and earplugs, all have slight aluminum sparkle in hair even after showering), Lai buffs iPad case after iPad case. iPad 2 has been released in the United States just weeks ago, and so many cases needed! Important to polish as many iPad cases as possible. Get priorities straight. Buff buff buff. Sand sand sand. Okay, so giant explosion caused by dust and inadequate ventilation blows up factory. Poor skinny Lai taken to hospital, where beautiful nursing student girlfriend recognizes him only by his legs because most of skin seared away. Giant bummer for everyone involved when two days later Lai dies.

Back to Amy in west Michigan. iPad screen smudged with her desperate fingerprints. What a night of suffering. Who knew so much blood could come out of her? Small but significant source of comfort is the pet she invented on one of those sites where kids can invent virtual pets. Cat named Lana kept Amy company. If Amy spoke at Lana, Lana repeated what Amy said. For instance, “I am going to feel better soon.” Cat said it right back to her. “Mom will get up soon and help me.” That was a good one to play back again and again and again.

Sure enough, Mom up at six, and — wow! — what a distinct and upsetting surprise to find Amy on a nest of towels sort of bleeding to death.

Let’s talk about shredded romaine lettuce for a minute. Too boring? Lettuce is boring. Let’s talk about State Garden (Chelsea, Massachusetts) Organic Spinach and Spring Mix Blend. The company’s web page is currently under construction, but the slogan under the Please excuse us while we undergo redevelopment of our website is “Where Freshness Comes First.” Let’s talk about raw clover sprouts on sandwiches at Jimmy John’s. No? How about industrial beef production process that results in workers sometimes nicking the intestines of cows during slaughter and thus releasing E. coli bacteria that have the potential to shut down little kids’ kidneys and kill them?

Okay, but Amy’s just lying here bleeding, so maybe time to stop talking about raw clover sprouts, time to load Amy into the car and get her to the nearest hospital.

Which Amy’s mom and dad (my sister- and brother-in-law) did. Now there, you see Amy in the back of the car, insisting on clinging to iPad with Lana the cat on it.

Back to China. No, wait. Take a few minutes in Cupertino, California. Apple execs hold special meeting to discuss rumors about working conditions for Chinese in their factories. Dust causing explosion at factory a super-duper bummer, yes, but “working conditions in Apple’s supply chain are safe.” Also, all “workers treated with respect and dignity.” Also, manufacturing processes “environmentally responsible.” I’m quoting straight from official documents here. So: respect and dignity good. Environmentally responsible also good. However: explosion not good. However also: there are an awful lot of Amys in America desperately waiting to buy new iPads, and if Chinese workers are too busy playing mah-jongg or whatever it is Chinese workers like to do in their off-hours, there won’t be enough iPads for all the Amys and sisters, brothers, cousins, etc. Granted, this particular Amy in Michigan is a good deal more desperate than some people, not even for an updated iPad (though in other circumstances she would certainly be thinking about/yearning for it), but for the comfort of Lana the cat with a pink bow around her neck on the screen Amy views as her parents rush her to Helen DeVos Children’s Hospital.

Difficult moment ahead: in the ER, nurses will have to pry Amy’s hands off the iPad so they can insert IV and perform a variety of tests to try to figure out why the hell an 11-year-old is shitting blood. Shitting blood more something older people do. And what the hell with the insane exorcism-like vomiting? Particularly rough moment when Amy screaming for Lana the cat becomes Amy sort of scream-vomiting/choking. Then, not long after that — wow! — the kid beginning to fill with fluid so that she starts to look like a bloated, inflated version of herself. Doctors unable to diagnose her, so while sitting by daughter’s bed, Amy’s mother, trained as a nurse, grabs iPad and begins Googling symptoms such as “blood in stool” and “renal trouble.” (Too scared to Google “kidney failure.”)

Did you know that the Salinas Valley in California is known as “The Salad Bowl of the World”? I would like to live in a place known for being a salad bowl. One of the problems in the Salinas Valley is that forests abut fields where vegetables are grown. Now, why would that be a problem? Well, sometimes, feral pigs come wandering out of the forest and into the spinach fields. Feral pig takes a shit in the spinach fields and contaminates future salad. I’ll give you another one: wild birds. And another: people hired cheap to pick produce have to go to the bathroom while working the fields. No place to wash hands. So, as one Internet commentator pithily put it: “Paco pooped on the produce.” Poor Paco: illegally immigrated from Ciudad Juárez and all he wants to do is pick enough spinach to give him food/clothing/shelter. Middle of the day, he has to go to the bathroom. You think there’s a shuttle bus that picks him up and brings him to a hygienic indoor facility where he can poop in peace? Think again. There’s another Paco in the Dome Valley of Arizona, not a Paco-sized spot of shade in sight, and the dude has to go to the freaking bathroom. If you were picking spinach all day and trying to drink enough water to stay hydrated, you, too, would be dying to take a piss/shit. So that’s what he does, between the rows of spinach, and the wily bacteria travel wherever wily bacteria will, and the bag of spinach Amy’s mom tosses into her cart at Frandor contains Escherichia coli, a.k.a. E. coli.

So basically we are talking about commerce. Commerce in lettuce, spinach, and iPads. Also, at some point, there should be a conversation about knockoff Prada bags and prescription drugs (Oxycontin, etc.) that one can buy over the Internet. But before that, I want to talk about a product called n-hexane. First, though, meet Bai Bing. Also, meet Wu Mei (not their real names). Both are young workers in the city of Suzhou who were poisoned by n-hexane, used to make iPad touch screens shiny. At first, Wu Mei noticed she couldn’t walk as fast as she was used to walking. She figured working long hours was tiring her out. But then her hands went numb, and then she had trouble rising from a squatting position. Hmm. Interviewed in her hospital bed, Bai Bing reported that she was suffering from dizziness and partial paralysis. Wow! — the n-hexane smelled pungent and nasty, but the workers had no idea it might cause paralysis and so on. But the thing about n-hexane is that it evaporates more quickly than rubbing alcohol — like, a lot more quickly — allowing workers to clean more iPad screens each minute. And the more iPad screens Bai Bing and Wu Mei can clean per minute, the more quickly they can be shipped out to eager American consumers like Amy.

Bai Bing was cleaning Apple logos when she fell ill. What a funny sentence, but I read it in a Guardian report. What would Jane Austen make of the words Apple logo? What’s a logo? Jane might ask. And beyond that: What’s an Apple logo? What does it have to do with apples? Furthermore, how does one clean an Apple logo? And how could one become sickened from cleaning an Apple logo? Apparently, it’s important for logos to be kept clean. Right? Ever seen a dirty logo? Dirty logos not good for business.

I’ve heard it said, “The difference between the First World and everyone else comes down to Apple gadgets.” What the First World really wants is gadgets, and we want them damn shiny. Oh, believe me, I understand how hard it is to connect the shiny surface of your most beloved gadget with some random Chinese workers you don’t even know having trouble walking and having to go to the hospital because they’re suffering from a little, er, paralysis. Plus that description of the Chinese workers with their skin and hair sparkling from aluminum dust sounds kind of magical, as if they’re Santa’s elves. And there’s something almost amusing/absurd about the image of eighteen Foxconn workers leaping off buildings to their deaths (though, of course, they didn’t all jump at once; they jumped alone, over a period of months). Not funny in a funny way but funny in that absurd Dada way when you think of poor Ma Xiang-qian and Zhu Chen-ming (such crazy names, these Chinese workers!) falling from the tops of buildings. And then even more absurd, how Foxconn installed safety nets afterward instead of, like, improving ventilation or shortening the workday. It’s just very difficult to see any connection at all between these shiny gadgets that do things like talk to you and keep all your appointments straight, and poor Miss Hou hanging herself in the company’s dormitory bathroom somewhere over there in China.

Another case (or three cases) in point: cantaloupe, sprouts, bagged spring mix. Each of these items caused an outbreak that completely messed up little kids and their kidneys. Also, Odwalla juice, which prided itself on being unpasteurized. So Mom gets an iced tea for herself at the airport, and her daughter wants an apple juice. Before you know it, the kid’s in the hospital with kidney failure, having been diagnosed with hemolytic-uremic syndrome. Which is horrible. Which has a 5 to 15 percent mortality rate. Higher in children. Oh yes, it’s about as difficult to imagine the lowly sprout or the bodacious but essentially quotidian cantaloupe causing your kid’s kidneys to shut down as it is to imagine your shiny gadget screen being responsible for the numbness in Bai Bing’s hands or the suicide of Zhu Chen-ming. Cantaloupes and sprouts are girly foods, foods for middle-aged women on diets. Cantaloupes and sprouts are about the furthest possible foods from undercooked hamburger (another E. coli culprit) one can imagine. It’s not hard to picture how a worker slaughtering a cow might accidentally puncture its intestines and release E. coli into the slaughterhouse. But how could cantaloupe carry deadly listeria? It’s fruit, after all. It has a goofy name. And sprouts! You generally don’t even eat the sprouts in your sandwich but instead leave them on the side of your plate because they are not delicious.

A couple of weeks ago, one of my “friends” on Facebook (I put friends in quotation marks because she’s not really my friend, just someone I knew in college, from which we graduated almost 25 years ago) posted a photo of “Minimum Wage Barbie.” The doll’s wearing a McDonald’s uniform and carrying a tray with a Happy Meal on it. Across the top of the doll’s box are the words GIRLS! This will be you if you don’t study. My “friend” added to her post, “I’ve been laughing about this all morning.” Now, you will probably accuse me of being overly sensitive and politically correct, but I walked around for the rest of the day thinking about Bai Bing and Wu Mei, Ma Xiang-qian and Zhu Chen-ming and their shitty jobs and their shitty useless dumbass deaths. They didn’t work in dangerous, low-wage jobs because they hadn’t studied hard at college. And in fact, I remembered that my Facebook “friend” hadn’t done much studying at the second-tier liberal arts school in the Northeast that the two of us attended. My most vivid memories of her include (1) Lilly Pulitzer pink-and-green pedal pushers and (2) a night in her dorm room when a bunch of us got drunk on Jell-O shots and ended up piercing each other’s ears with a needle dipped in rubbing alcohol.

Mostly, said Facebook “friend” posts about “Quonnie,” a preppy pet name for Quonochontaug, an area in Rhode Island composed of three beachfront communities. Apparently, this “friend” owns a beach house in the area that serves for her as a kind of emotional/spiritual polestar. So if she’s having a bad day, she might post on Facebook a photo of the beach at Quonnie with the words going to my happy place superimposed on it. One imagines that the kind of bad day that might send my college friend to seek the solace of her happy place might involve something more serious than not being able to find slipcovers that match the living room sofa and something less serious than working really long days at an unventilated factory in China while being poisoned by n-hexane used to clean iPad screens.

If you’ve seen Lilly Pulitzer clothes once, you’ve seen pretty much what Lilly Pulitzer clothes have been about since Lilly herself married a businessman and moved from New York to Palm Beach, where she (no joke!) set up an orange juice stand. Legend has it that she began designing brightly colored and patterned dresses to hide juice stains when she was working. Even with the Internet’s vast informational reach, it’s hard to figure where the pink-and-green pedal pushers are being made now, though the company’s website has a breezy line about how “From South America to the Far East, our product is made all over.” The distribution center is in Pennsylvania, but all we know is “some of the garments travel a long way on a sea vessel and some others take a quick 21-hour flight on a plane.”

One time in college, I needed a dress for a formal, and a bunch of my sorority sisters and I were going to Hilton Head, South Carolina, for spring break. Now, the college I went to was very expensive, so my parents took out a second mortgage on their house to pay my tuition. To pick up the spending money I felt I needed in order to keep up with my wealthier sorority sisters, I’d gone off the meal plan. I used the refunded money to buy groceries, which mostly amounted to single-serving cans of Progresso lentil soup, cases of Diet Coke, and a weekly bunch of bananas. By the time we got to Hilton Head, I’d squirreled away enough money to buy a magnificent cotton dress, green with coral and white flowers. It wasn’t a Lilly Pulitzer, but it was snazzy.

“A sweetheart neckline!” one friend exclaimed.

“Now you need peau de soie shoes!” another friend exclaimed.

I pretended I knew all about sweetheart necklines and peau de soie shoes.

Peau means “skin” in French, and soie means “silk,” so I would’ve known the meaning if I’d taken French like everyone else at my college, rather than Spanish, language of Paco.

Somehow, I have gotten very far afield from Amy in Michigan, who has now been moved to pediatric ICU and placed on a ventilator. Her lungs are filling with fluid, which causes her to struggle to breathe. When the doctor suggests that he intubate her, get her on a ventilator, and sedate her, Amy turns to him and says, “Bring it on.” Which reminds me: what did bring it on? Was it a fast food hamburger like the ones at Jack in the Box that poisoned children in Seattle in 1993? That outbreak resulted in the largest food-borne illness settlement ever made in the United States, to one Brianne Kiner, a nine-year-old who nearly died after eating a hamburger contaminated with E. coli. Or could it be the girly sprouts or the girly cantaloupe or the spring mix that comes in the big see-through plastic clamshell that has phrases printed on it like “triple-washed!” and “ready to eat!” The truth is that right now no one knows what the hell got into Amy and caused her kidneys to shut down. The bloody diarrhea and subsequent diagnosis of hemolytic-uremic syndrome (HUS) have been reported to the county health department, which faxed over to the hospital a questionnaire aimed at determining a possible cause of the E. coli infection. At the present time, the questionnaire sits in the waiting room, under a pile of papers under Amy’s mother’s winter coat, while Amy’s mother, when she’s not hovering over Amy, sits listening to Christian rock on her iPod headphones while rocking back and forth and moaning.

In short, when your kid’s suddenly dying in the hospital with kidneys that aren’t working, the last thing you’re likely to do is fill out a questionnaire faxed over from the health department about what and where said kid might have eaten the last 10 days. Especially if said kid asked you just before they intubated her if she was going to die.

Fast forward. Amy’s mom has now been in the hospital going on two weeks with Amy, her second oldest daughter, and has consequently lost time/date orientation. Is it day or night? Thursday? Sunday? Breakfast? Dinner? If Sunday, then must make effort to attend large evangelical church to which family belongs. No, not going to church even if it is Sunday. Instead, she remains by Amy’s bedside with iPad in lap, reading scripture — for instance, Exodus 23:25: Worship the Lord your God, and his blessing will be on your food and water. Also, Hebrews 9:22: Without the shedding of blood, there is no remission of sins. There certainly has been a lot of shedding of blood, that’s for sure, Amy’s mom thinks, remembering Amy bleeding through the pile of Lynx’s dog towels on the bathroom floor.

My husband’s aunt, a sage who worked for the U.S. Public Health Service, once opined over a martini, “The key to a healthy populace lies in separating people from their poop.” She had endeavored to do just this while being posted in Africa. Turns out that in Africa, E. coli is caused by feces being used as fertilizer or feces tracked into factories on shoes of workers or feces getting into water supply. Fecesfecesfeces. One thing Amy’s mother would like to stop thinking about is feces. Another is pee, which Amy hasn’t produced in days, thereby causing Amy’s parents to find themselves praying for pee. Saying pee prayers. Kneeling in prayer for the promise of pee. Amy’s father even spent some time combing an online Bible for references to pee production. The parents have been told that Shiga toxins are responsible for Amy’s current state. The term sounds exotic, and in some sense, it is for Westerners, having been named for Kiyoshi Shiga, the Japanese bacteriologist who, in 1897, discovered the toxin that causes dysentery. Imagine having a toxin named after you! Wow! — even crazier, imagine your 11-year-old on a ventilator in pediatric ICU when just two weeks ago she was hugging the iPad and the karaoke machine she received on Christmas morning. Hugging them, that’s how excited she was. Funny to think about how kids get attached now to consumer electronics, whereas when Amy’s mom was a kid, she hugged a Baby Crissy doll with a ponytail that grew when you pulled it. Did you know that karaoke is a portmanteau of the Japanese kara, meaning “empty,” and okesutora, meaning “orchestra”?

The elite class in America — the Kennedys, the Rockefellers, the Vanderbilts, the Whitneys — has a thing for cotton print skirts and trousers with garish pink-and-green-flowered patterns splashed across them. Go figure.

I think I’m losing control of this story.

The empty orchestra of the burbling fountain in the pediatric ICU, designed to muffle the sounds of families communicating the intimate details of their children’s illnesses or the intimate sounds of families weeping.

The empty orchestra of the street in Chengdu after aluminum dust produced from polishing iPad screens caused the factory to explode.

The empty orchestra of the shit the immigrant worker takes in the field of spinach.

Of E. coli in the slashed intestines of the cow hung upside down.

(Loss of iPad production from explosion could reach half a million units).

In college, for a while, to afford the sweetheart necklines and peau de soie shoes, I worked a morning shift in the dining-hall dish room. The work stank of burnt toast and bleach. After the breakfast rush, I would walk back across campus to my dorm and take a hot shower.

I read in The New York Times: “New screens began arriving at the plant near midnight. A foreman immediately roused 8,000 workers inside the company’s dormitories, according to the executive. Each employee was given a biscuit and a cup of tea, guided to a workstation, and, within half an hour, started a 12-hour shift fitting glass screens into beveled frames. Within 96 hours, the plant was producing over 10,000 iPhones a day.”

Three weeks have gone by since Amy invented a screen cat and programmed it to tell her she would feel better soon. As she breathes more easily on her ventilator, her body ever more overwhelmed with toxins her kidneys can’t filter, her father uses his daughter’s iPad to send a Facebook update to friends around the world: “Praise the Lord. He shall guide us.”

Thirteen days after Amy was discovered to be infected, her youngest sister, Ava, age five, manifested symptoms nearly identical to Amy’s and was admitted to a room right beside her sister’s in pediatric ICU. On his Facebook page, the girls’ father posted a status update that said simply, “In what feels like a punch in the face, my youngest daughter has also been diagnosed with HUS.”

Update: Amy and Ava were both close to death in January 2013 when their doctors convinced the insurance company to let them treat the girls with a drug called Soliris (generically, eculizumab), which was flown in on a special flight from Boston to Michigan. Soliris is one of the “11 Most Expensive Medicines in America”; in fact, it has been named by Forbes.com as the “world’s single most expensive drug, coming in at $409,500 a year.” Even more expensive, now.

After extensive dialysis, both girls were given a clean bill of health in March 2013.

The source of the E. coli infection has not been found.

Suicide nets installed two years ago after nine workers jumped to their deaths at the Shenzhen factory remain in place.

The only part of this essay I have invented is the dog Lynx.

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Editors' Note

This essay was published, under the title “Food and Worker Safety Across the Globe,” in the latest issue of Creative Nonfiction. It appears here with the permission of the author and publisher.